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NPI Code Detail

MEDICARE: MUSTANG RIDGE HEALTHCARE, INC.

MEDICARE: MUSTANG RIDGE HEALTHCARE, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1912576372
Entity Type Code : Organization
Provider Name (Legal Business Name) : MUSTANG RIDGE HEALTHCARE, INC.
Provider Business Mailing Address
First Line : 8324 CAMERON RD
Second Line :
City : AUSTIN
State : TX
Zip : 78754-3990
Country : US
Telephone Number : 737-241-0800
Fax Number : 737-241-0801
Provider Business Practice Location Address
First Line : 8324 CAMERON RD
Second Line :
City : AUSTIN
State : TX
Zip : 78754-3990
Country : US
Telephone Number : 737-241-0800
Fax Number : 737-241-0801
Authorized Official
Title or Position : TREASURER
Name : SOON BURNAM
Credential :
Telephone Number : 949-540-1249
Provider Enumeration Date : 06/21/2021
Last Update Date : 06/21/2021

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Directions to “MUSTANG RIDGE HEALTHCARE, INC. ” Practice Location

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